Team Lead – Member & Provider ; US Healthcare

Position: Team Lead – Member & Provider Support (US Healthcare)
Job Title:

Team Lead – Member & Provider Support (US Healthcare)

Location:

India / Philippines (Onsite)
Reporting To:
Operations Manager – Member & Provider Services

Role Overview
The Team Lead – Member & Provider Support is responsible for managing a team of Support Advocates delivering high-quality, voice-based service to US health plan members and contracted providers.
This role drives operational excellence through performance management, coaching, quality governance, compliance adherence, and SLA delivery. The Team Lead serves as the first line of leadership, ensuring team engagement, productivity, and service outcomes within a highly regulated US healthcare environment.

Key Responsibilities
1. Team Leadership & People Management
Manage a team of 15–20 Member & Provider Support Advocates.
Conduct daily huddles, weekly reviews, and structured coaching sessions.
Drive team engagement, morale, and retention.
Identify skill gaps and coordinate refresher training sessions.
Provide real-time floor support and escalation guidance.
Develop individual performance improvement plans where required.
2. Operational Delivery
Ensure adherence to SLAs including AHT, Quality, FCR, CSAT, and Productivity metrics.
Monitor real-time queues and staffing alignment in collaboration with WFM.
Analyze performance dashboards and implement corrective action plans.
Ensure first-level resolution of member/provider escalations.
Maintain daily, weekly, and monthly performance reporting.

3. Quality & Compliance Governance
Ensure strict adherence to HIPAA and healthcare regulatory standards.
Drive audit readiness and documentation accuracy across the team.
Conduct call listening sessions and quality calibrations.
Reinforce compliant communication standards and process adherence.
Proactively identify and mitigate regulatory or compliance risks.
4. Stakeholder & Escalation Management
Act as the primary point of contact for internal stakeholders regarding team performance.
Manage complex or high-risk member/provider escalations professionally.
Identify recurring trends and share root cause analysis with leadership.
Support continuous improvement initiatives and process enhancements.

Required Experience & Qualifications
Mandatory Requirements
2–4 years of US Customer Service experience (voice-based).
Minimum 1 year of team handling experience in a US healthcare environment.

Minimum qualification:

High School Diploma (mandatory);
Graduate preferred.
Strong knowledge of US Healthcare processes (Medicare Advantage preferred).
Proven experience managing performance metrics and coaching teams.
Willingness to work in US rotational shifts (7-day operational environment).

Preferred Qualifications
Exposure to Medicare Advantage, Commercial, or Medicaid health plans.
Experience in Member Services and/or Provider Services operations.
Familiarity with healthcare platforms such as Facets, Salesforce, or similar systems.
Experience working in audit-driven, compliance-sensitive environments.

Core Competencies
Strong leadership and people management skills
Performance management and coaching capability
Analytical and data-driven decision-making
Escalation and stakeholder management
Compliance-focused mindset
High accountability and ownership
Ability to manage high-pressure, high-volume environments

Work Environment & Expectations
Voice-dominant, high-volume contact center environment.
Continuous monitoring of KPIs and quality benchmarks.
Mandatory completion of HIPAA and compliance certifications.
Flexibility during peak business cycles (e.g., AEP/OEP enrollment periods).
Ongoing coaching, calibration, and performance reviews.

Career Progression Path
Assistant Manager – Operations
Operations Manager
Program Manager – US Healthcare Operations